MEDICARE: HABASHI DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3207	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11671512	OTHER	NV	UCC ID #
3	199299	OTHER	NV	UCC ID #

General Provider Information

NPI Number	:	1245251115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HABASHI DENTAL PC

Provider Business Mailing Address
First Line	:	3417 S JONES BLVD
Second Line	:	STE F
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6784
Country	:	US
Telephone Number	:	702-368-5111
Fax Number	:	702-362-5115

Provider Business Practice Location Address
First Line	:	3417 S JONES BLVD
Second Line	:	STE F
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6784
Country	:	US
Telephone Number	:	702-368-5111
Fax Number	:	702-362-5115

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	AFSHIN AND TOURAJ HABASHI
Credential	:	DDS
Telephone Number	:	702-368-5111

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	08/22/2020

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Directions to “HABASHI DENTAL PC ” Practice Location

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